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. 2021 Dec 20;39(36):4039-4048.
doi: 10.1200/JCO.21.01195. Epub 2021 Oct 22.

Predicted Cure and Survival Among Transplant Recipients With a Previous Cancer Diagnosis

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Predicted Cure and Survival Among Transplant Recipients With a Previous Cancer Diagnosis

Eric A Engels et al. J Clin Oncol. .

Abstract

Purpose: A previous cancer diagnosis is a negative consideration in evaluating patients for possible solid organ transplantation. Statistical models may improve selection of patients with cancer evaluated for transplantation.

Methods: We fitted statistical cure models for patients with cancer in the US general population using data from 13 cancer registries. Patients subsequently undergoing solid organ transplantation were identified through the Scientific Registry of Transplant Recipients. We estimated cure probabilities at diagnosis (for all patients with cancer) and transplantation (transplanted patients). We used Cox regression to assess associations of cure probability at transplantation with subsequent cancer-specific mortality.

Results: Among 10,524,326 patients with 17 cancer types in the general population, the median cure probability at diagnosis was 62%. Of these patients, 5,425 (0.05%) subsequently underwent solid organ transplantation and their median cure probability at transplantation was 94% (interquartile range, 86%-98%). Compared with the tertile of transplanted patients with highest cure probability, those in the lowest tertile more frequently had lung or breast cancers and less frequently colorectal, testicular, or thyroid cancers; more frequently had advanced-stage cancer; were older (median 57 v 51 years); and were transplanted sooner after cancer diagnosis (median 3.6 v 8.6 years). Patients in the low-cure probability tertile had increased cancer-specific mortality after transplantation (adjusted hazard ratio, 2.08; 95% CI, 1.48 to 2.93; v the high tertile), whereas those in the middle tertile did not differ.

Conclusion: Patients with cancer who underwent solid organ transplantation exhibited high cure probabilities, reflecting selection on the basis of existing guidelines and clinical judgment. Nonetheless, there was a range of cure probabilities among transplanted patients and low probability predicted increased cancer-specific mortality after transplantation. Cure probabilities may facilitate guideline development and evaluating individual patients for transplantation.

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Conflict of interest statement

Gregory HaberEmployment: Asklepion Pharmaceuticals (I) Allyson HartResearch Funding: CSL Behring (Inst) Charles F. LynchResearch Funding: Pancreatic Cancer Action Network (Inst), Novo Nordisk (Inst), Lilly (Inst)No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Cure probabilities of patients with cancer in the United States. The results are shown as overlapping histograms for (blue) all patients with cancer in the general population at the time of diagnosis and (red) the subset of transplanted patients with cancer at the time of solid organ transplantation.
FIG 2.
FIG 2.
Observed and predicted cumulative incidence of cancer-specific mortality among patients with cancer. The observed results are shown as Kaplan-Meier curves, and the predicted results are shown as horizontal dashed lines calculated as 1 minus the mean cure probability from the cure models. (A) The results are shown for patients with cancer in the general population for tertiles on the basis of the predicted cure probability at cancer diagnosis. (B) The results are shown for transplanted patients with cancer on the basis of the predicted cure probability at the time of transplantation. Note that the vertical axes differ in the two panels.

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References

    1. Engels EA, Pfeiffer RM, Fraumeni JF Jr, et al. : Spectrum of cancer risk among US solid organ transplant recipients. JAMA 306:1891-1901, 2011 - PMC - PubMed
    1. Grulich AE, van Leeuwen MT, Falster MO, et al. : Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: A meta-analysis. Lancet 370:59-67, 2007 - PubMed
    1. Engels EA: Epidemiologic perspectives on immunosuppressed populations and the immunosurveillance and immunocontainment of cancer. Am J Transplant 19:3223-3232, 2019 - PMC - PubMed
    1. Hart A, Engels EA: Balancing uncertain risks in candidates for solid organ transplantation with a history of malignancy: Who is safe to transplant? Am J Transplant 21:447-448, 2020 - PubMed
    1. Faitot F, Michard B, Artzner T: Organ allocation in the age of the algorithm: Avoiding futile transplantation—Utility in allocation. Curr Opin Organ Transplant 25:305-309, 2020 - PubMed

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